Journal of clinical anesthesia
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We describe the first case of severe hypernatremia associated to laparoscopic surgery for hydatid cyst in an adult patient after the use of hypertonic saline solution with complete resolution. Severe hypernatremia is an unusual fact at the immediate postoperative period but may have fatal consequences for the patient and need immediate action. ⋯ The relation between this surgical technique and the severe complication is discussed. More experience is needed in terms of safety for the patient.
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Renal cell carcinoma has a tendency for vascular invasion and may extend into the inferior vena cava and even into the right-sided cardiac chambers. It has been reported that nephrectomy with thrombectomy can provide immediate palliation of symptoms with 5-year survival rates of up to 72% in the absence of nodal or distant metastasis. ⋯ Renal cell carcinoma with vena cava tumor thrombus extending into the right cardiac chamber usually requires cardiopulmonary bypass and occasionally deep hypothermic circulatory arrest for surgical resection, and anesthetic approach should be tailored to each individual case. Thorough preoperative evaluation and the commitment of a multidisciplinary surgery team are indispensable.
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Case report. ⋯ Tension pneumomediastinum was the likely etiologic factor for the acute hemodynamic collapse and should be considered in the differential diagnosis of intraoperative circulatory arrest.
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Various hypnotic techniques are used in anesthesia, either on their own or as adjuncts. A new hypnotic technique, hypnopraxia, was tested in 5 patients undergoing various procedures (4 colonoscopies, 1 inguinal hernia repair, and 1 transobturator tape procedure). The patients were accompanied throughout the procedure by an anesthetist trained in hypnoanesthesia and hypnopraxia. ⋯ This preliminary experience with hypnopraxia would tend to show that this technique could be useful in the anesthetic setting. More experience is obviously required with hypnopraxia in anesthesia so as to improve the technique further, and to determine its implications, if any, for the patients and for the procedures. Furthermore, it will be of the greatest interest to determine, before carrying out any procedure with hypnoanesthesia, which patient will benefit most from which hypnotic technique.
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To determine whether epsilon-aminocaproic acid (EACA) load of 50 mg∙kg(-1) before skin incision, and infusion of 25 mg∙kg(-1)∙h(-1) until skin closure during cranial vault reconstruction (CVR) were associated with decreased estimated blood loss and transfusion requirements. ⋯ Using a standardized dosing regimen of EACA during craniosynostosis surgery, we found statistical significance in blood loss and transfusion requirements in surgeries of the shortest duration. We suspect this may be due to our selected dosing regimen, which may be lower than recently recommended. This study contributes to the growing body of evidence supporting EACA in CVR for craniosynostosis.